Bossed to Death

This is Jane Orient, MD, of Tucson, Arizona and head of Association of American Physicians and Surgeons, responding to the Cato report described here:

So just who should be my boss? What credentials? What oversight of the boss? Who gets sued if there's a problem?

The "project manager" in cases like Mr. Kling's used to be called "doctor." Seeing to all those details used to be my job when I was the attending internist rounding on my private patients in the hospital, calling the consultants but doing all the medical work outside of the specialty procedures, always looking for trouble.

I don't do that anymore; very few doctors do. They rely on hospitalists. Reasons: (1) They don't get paid. (2) They do get hassled constantly by managers with clipboards, not to mention Medicare bureaucrats. They have to cope with increasingly complex although largely pointless, legalistic hospital procedures and impossible Medicare billing requirements (and threats of draconian fines and prison terms for errors). Probably worst is the lack of experienced, well-trained nurses who know their patients and are familiar with the hospital unit because they work there all the time.

A job that interns used to be able to do, with the help of a good nursing staff, is now probably impossible for any human being, thanks to all the bosses, supervisors, overseers, committees, risk management, quality assurers, teams, team leaders, managers, utilization reviewers, etc.

Pretty soon you won't be talking about bosses for doctors, because there won't be any doctors. Who needs them anyway? If the project manager is capable of bossing the doctor, and if he's a hospital employee gets paid even if the doctor doesn't, why doesn't he just do the doctor's job?

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